20171329 Ver 1_Shoreline Stabilization_20171016

Duke Energy Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ _ Security Deposit $ Check ✓# Date Recv'd_— Initials
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Date Initials
Date Final Protection/Avoidance Area Markings Field - Verified
Initials
Approved to Start Work By * : Date
{flint) (Slgn)
Date Completion Required Date of Any Approved Extension Initials
Date Passed Closeout Inspection*
Initials
Any Stop Work orders or SMG Violations*? (check one) [3Ycs C1No (#Yex, explain in PART V)
Date Deposit Retl►nded . Initials Date Permit Database Updated Initials
* Forward copy of approved application (ail pages, plus any attachments that nuke Energy changed) back to applicant
with Approval Letter and highlight any changes. File copies of Approval and Close-out Checklists and any Stop Work
_ Orders with application.
Part I. Applicant Information (Please Print)
Name Mok-re nl Gf AIA16-13 �c'(� f�,q ry 13 Snti-A
Email address: %%%Q A"e. C—O � e 11510 � . AIL 7L
Lake Address
/ 9 515 MA}46A-i
COY-nr( /,u5, ^rC X03I
Telephone (� S9a - tr iW
Mailing Address (if different)
OCT 6 2017
Contractor Company OWC. Q 4e-adf n!4
Contractor Contact Person�Oh c s Telephone (7!a) 6 (00.5-111
Contractor Email Address: �,v C SCA-09�/ � s—P W %Ayd 4rtA vm • ,rt f
LAKE LOT INFORMATION l
Lake I orM/I� County MY CK City �A& ("As State AA Tax Map No.
Subdivision—1 tpeid r'µlStt �a� Lot/ Section No. L1 O F71 Lot Size Acres
161- 0-5-31
170 - 0. (671�
s
-Tt 5 15 ogc P I cy-- w*\ TV\.\re--e— 6 `` ©.
Duke Energy Page 4 of 14 rev 2/6/17
Excavation Program

2017 New Dredge Application.... 2 /16
A
Duke Law- EsXOtlon pert ARgkation Form
Am there any Co-ApplicanWO (check une) ClYes [33�No (If Ye..�, 111clude names, addresses ar
lot 111'Unber's, phoiw numbers, 1,01 sizes in PARC V — AODVVIONAL (IN FORNIATION)
* CO -Applicants exist when the proposed work is tieing done under a single application, will be
Wormed by a single contractor as one continuous project. and is done to benefit multiple
owners I lease holders of Project -front properties within a single development. The check for the
application filing foe and security deposit -should be from the party shown as Applic=t and not
sovenal chccks from the Applicant and Co -Applicants.
Do not continue the applicationt Mntfl an Ou-sitt inspection has been conducted between it
Duke Energy Lake Representative and the app cant and/or the txcavadon contractor.
iVOTE-* Initializing this Pardon of the application by a Lake Representative in no way
COOSliftims aMrOwd Or eminent approval of the excavadon or any other Jake use permitdng
activity.
Date of on-site inspection, 7
Initials (Duke "nergy) (appucaut/Contractor)
Duke Fr Page 5 of 14 MV 2?,6017
Excavation Program
1-41 It a X

2017,New Dredge Application.... 3 /16
Duke EneEU fix_ ea Permit AgLUcIfta Form
Part It. Description of Project
.. I
I - Type of excavation: (check one) . I New excavation 0 Maintcn=ce exca-vation
2. Purpose of excavation: (check one) Boat Access Channel
0 Water Intake C�tannd `'Wizstemuter Discharge Cliantiel
Lake u= category: (check one) * rivate OResidential Marina
OCommercial Manna Opublic
C30ther (specify):
4. Max. Excavation Area Dimensions (ft): Length, Width
Depth
(Note: inchuie additional arewdiinen-siom if necessary so response e) 45 below equals inns. area
dimensima in #4)
S. Volume of Excavated Material (TOTAL for the praject) 5 *—L—Cubic, yards
6. Tye ofmauxial rmoved (applicant determines byfield sarnple ractical): /vAad *' S i /f-
1. Excavation Site areu: 0.01
A,re (5) Dispo.�ul Sitm arca: 'Acre
N
8. Total Disturbed Area (inch ding equipment staging area):Lt±_ Acre (s)
9. Does the project meet the requirements of the applicable General Permit! (check one)
)dYes ONo
M Do you claire title to the disposal area'' ilchedl one) 9111 CS No
11. Do you claim title to the equipment staging area? (check- one) XYes ONO
12. Are there any water-tmtment facilities within 50 feet of the proposed excavation area?
{check one) OYes ;&No
(If Yes. specify).
13. How will the excavatedmaterial be eptrapped and th, cru) 'Um watrolta? (e.g. see attached
Band erosion control plait disposalarea desig—
n):- hy� X*r-4e,
Duke Emp, Page 6 of 14 Tec ?N17
Excavatkuln Pumrain

2017 New Dredge Application.... 4 / 16 j ra X
I1dS9,-,En,erj,y Exe vat on F`er it rForm
€4. Type(s) of excavation equipment to be used: 19 A -r4 c. W IDNq rCl`i�G�� �'R1/�-74+r
15. IVill hinters or wetlands be crossed in trtmsporting equipment to or from the site?
(check tine) [Yes PO
16.. Will rete eater re-enter there v{) r (C`/ieckone) E3Yes No Olti€iA (ff Yes, Fpecjj�
pol"(s) Of're-erg and show on cation area Drawing)
17. Is there an. ting facility (e.& pier) that mess is being maintained to by conducting the
excavation? es CINo
(if Yes. vec fg the existhkg I` errralt rnr€m bob i ,;d��, 'rartUde a scaled (Ira-,,j� ��` �`tc� proposed
J tity). penznit ..5�. ivi,,r j^1 c�C ,q-c�'(; r�
IS. Total planned duration of the work (Include, wsJ,t egj1prnent rwbalLatian, excm=rttivn
through fin a!' m1 g�atitrp Measures -complete -y
START _.d r �L% HN ISH ,�_ ?o/ %
(MOnth) (Year) !' 'oats# j ('Year

Duke Energov ExtayaAgo Permit LLPROCIft-F.Oft—I
PART 11. (Continued)
gfjQhLAVOIDANQE AREA DR—SCRMQN,
Complete the following table including all land area within and immodizitoly adjoining the disturbed area:
ftqgg dugx "Weam
(ChO4* all AM appiy)
d
Ma,%-JdiiadswaaW� pt ndt;, bemficial
;�u�a #c veguadon or odw potentiji wedanb
Wrd('udl Ik4T CWIY)
U. laufftr Zon" (Speofi , width A.Worre
of mviar"men')
ljgrp- tollt
<- Od
c. Favironmental Ams as i&-tkfifkd by
I wi-bly
11- Na wtal Ams as kknt'iFlerby -Duke
Ealy
__j, Historic properties (spc-vf.9
IfA
f. Rare or threatenW sjvckm (i J
�/
_ _ A.
Diake, Energy
Excavation Progratri
Page &of 14
CM
rn
Cm
K
E2

Du -kc quer guera
PrqteeCgw'Avgid
AvoW t,&) g[A'I_It�
(c kck, � III ihal vv*v)
F
BuriLdgas, w4tcr, sewer,
communicaums t,:- ck�-ctric fines (circic)
b. InqmclMinimization t=ones as
!dc—n tKed by Du k c J "n agy
, ( f Vl
Other at, requmna specific
avoidamr-, protecisjon or mitigation (.vpec-4ty)
For "Field ID- colum, specify .,miity or 13erson that perfiwmed the identificabou and how it was phy, i e.g f u
. , cWly marLod ) k c (
Eticr&y (John Ooc)Mink and purple -coned tape, Corps of Erig. (Jo4m Smith)/yellow- flagging). For"Work Area Owg JW coluum,
sbow the symboli that is used on dic sits witigs to identify the. protection/avoidmice an:a.
** List and attach mitigation plan-,
Duke Energy
E, XCavtk I ion pyngra m
Page 9 int'14
rcv bWI 7
I*
K

- Lafare DWR Form.pdf 1 / 3
DWR
Omsion of Waftr R"Owrtes
State of Not -U) Carofirw.
Depararient of Emmmment and NaWmi fiesourm.
Ovistart d 'No -ter ries limes
15A NCAC 02H :0f-00 - Water Quafity Certtficatior�, Sht)refine Stabilization
FORM: :�"= XQ;Iw �
Shoreline Stabikation Application Form
Three copies of the application (including attachments) and the appiication fee should be sent to:
Division of Water Resources
401 &- Buffer Peartitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
ApAcant ftftmaWn 11f,& tlg�-OI-H�.0502 a�'
3, Owner Information
Name: (�,' Ii er-t A , L A FA 44mezraW 6tWNCde-46' I (r*AIY 13. sm;fA
Mailing Address: ZE43/5 MALIA-158i I POW -re— I)VI.
Telephone Number; Fax Number.
E-rnaii Y-& C" -a-
2. Agent/ Contact Person, information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
=:/Jwww.4a . sace.army. -latory/readocs/Lermits _LE &
psace.armv,milftrtaisIS9/docs/rego _ /5AMP AG NT AUTHO
RIZATLQFD9M.jx—ffl must be attached if the Agent has signed this application form.
7 --
Mailing Address.�
Telephone Nurntier'
E-mail Address:
Fler5or, to receve thE
#- iai e
11. Project inforrnation 15ANCACQ05QZ(,jj,AIb}
j
1. Attach a Vicinity map (i.e, street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads,
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetatiurl
j Ct-,I
tip p ra p, exc ava ti, on oz dredging bel0 w F. tall P o nd/ Norm Al Water L_avr--! e f evaV ons„ a nd
FORM: -;SGP 10-2014 pw- 3 Of 3

Lafaret D}WR Form.pdf 2 / 3 A rA X
construction access corridors. You may use the diagrar,: provided at the end of th;i
application form.
3. Attao a phot of *,e shoreline/ buffer provosed to be stabilized. (include a scale of
some sort- a yard stick, shovel handle, etc.),
4. Location of the property (where work is to be conducted)
County: Nearest Town. CO+f c,[ �u 5
Subdivision name or site address (inc—hide phase/lot number)- �}} � �N � r✓3�- �•
70J 1
Directions to site - please include road names and num- bers, NndmaO-s, etc.:. -7-1At
of Dr, -F i AAr`/u5A,' j..Ab
L tttUde ;in cFar;mrra d.grtE'_5; 55 rte' Longitude -7
S. Describe the existing land use or condition of the site at the time of this application
f re s`dertia*t, a °"d V e cp it"d, et -,e- -=f "k IV
6. Property size (acres):C* O• 5-3 1 ) 1-70(C.&74) I-
7.
-7. Lake/ river/ ocean adjacent to property. AID a 4f 4A/
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or wily it is necessary): �►- cctf� 4 t"� s �o� � ��55
9. Wiil work be conducted from land? ? From water? IX
10.1 oral amount of disturbance (including all excavation, backfili, rip rap, retaining walls, etc.)
below the normal pmol take level/ Normal Water Level in square feet or acres:
445
11. Total amount of disturbance (including 311 clearing back fill, excavation, rip rap, retaining
ways, etc,) above the normal pool ;oke leve'/ Normal Water Level and 50 feet !arid -ward in
square feet or acres:
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50
feet landward to be impacted (number of trees, for instance): J 1 55 . 5 %
G, -A
Owner/Agent's Signature' Printed Name ate
[iSA NgAC 02H.0502(f)
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: 55GP 10-2013 Page 2 of 3

Lafare DWR Form.pdf 3 / 3 i keA X
ft
Norma
SA
Lake
(At f -„ft t- d/wa %%w IsN-J,
65`
'Tease a roxunately sket6 &te fc wing information ort this .pian tprrs * dii! *nskm for &xh
trerr, such tis Itl j`r x IOO frj `:
2. All proposed vegetation clearing
2, Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
i Locat=on cf Of, rap or fill tr.- place* bAimm thr Fuji Pone/ Normal Water Level elevation
4. Loca of of}y propos s ioc: ores such as liuik4np, fetainit* wails, &4.4, Etc.
S. Location v€ any excav t+on cr dree.'ging below tie FOR Fond/ Nrrrrat later Level elpuation
6. Location of construction access conidon
FOKMt SSGF e0-zo., poge 3 Of 3

2017 New Dredge Application.... 7 /16
C. A
Comments -
Duke EneW Excavation Perrait Application For
Moi MtWsotil 'PoilJ1
Applicant Name Ib A L -a— —IFO--V-e Lot 4, 1
Appllcant.Siggnature4 0 -4 -SL— Date
Co -Applicant Name (,print} #4L)R-reAJ U A X E -74C -Q6
Co -Applicant Signature* qaaa�,
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name {print)—
CO-Applicant signature"
Co -Applicant Name tPrinO
Co -Applicant Signature'
lCo-Applicant Mame
Co-ApplIcaut Signature ' -5,
Lot #�---A'Ib ----
Date S)A36L
Lot ,4 �'I I - -,-. -
Date —*113�-,
Lot A
Date
Lot P
gate
Lot
Date
*Per my signature, the information proArided in this application is correct to the best of any
knowledge. I -
Dukt Energy Page 10 of 14 rev 1W I?
F--,oatviition Frugram

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Google Maps
Go gle Maps
Map data Oc 2017 Google United States 200 ft
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https://www.google.com/maps/@3 5.4618569,-80.9167433,17z 8/28/2017

MapCard - Print your custom map
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